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Symptom burden and its functional impact in patients with “symptomatic” relapsed or refractory multiple myeloma

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Abstract

Purpose

Relapsed or refractory multiple myeloma (RRMM) is labeled “symptomatic” based on laboratory values, but not relevant to quantitative measure of patient’s perspectives. This study aimed to describe symptom burden, health status, and quality of life in RRMM patients.

Methods

The cross-sectional study included 184 MM patients (141 RRMM cases and 43 MM patients on follow-up without diagnosis/treatment of RRMM disease as controls), while 64 RRMM patients also provided longitudinal patient-reported outcomes (PROs) data. Symptomatic status was based on clinical measures of disease activity. PROs included the MD Anderson Symptom Inventory multiple myeloma module (MDASI-MM), single-item quality of life (SIQOL), and EuroQol-5D (EQ-5D). Wilcoxon rank test and effect size were used for comparisons. Regression models were used to describe symptom trajectory and to identify predictors of high symptom burden during 3 months of RRMM therapy.

Results

Most patients were clinically identified as symptomatic (93%). RRMM patients tended to report more severe symptoms, with significantly lower QOL scores and more severe fatigue, poor appetite, and lower enjoyment of life compared with controls (all p < 0.05). In RRMM patients, lower hemoglobin and higher B-2 microglobulin levels significantly correlated with higher burdens of fatigue, pain, and muscle weakness and also with lower QOL and EQ-5D scores (all p < 0.05). During RRMM therapy, being female, with any comorbidity, ≥ 65 years old, and ≥ 5 years MM history, contributed to high symptoms burden and poor QOL status (each p < 0.05).

Conclusions

MDASI-MM modules were sensitive to detect the RRMM-related symptoms burden, which correlated with objective clinical measures. RRMM patients reported a more compromised QOL.

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Funding

The study was supported by the Bristol-Myers Squibb and the National Institutes of Health/National Cancer Institution under award number P30CA016672 and used the Clinical Trials Office.

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Authors and Affiliations

  1. Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA

    Mona Kamal, Xin Shelley Wang, Qiuling Shi, Loretta A. Williams, Hui-Kai Lin, Araceli Garcia-Gonzalez & Charles S. Cleeland

  2. Bristol-Myers Squibb, Princeton, NJ, USA

    Teresa M. Zyczynski & Catherine Davis

  3. Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA

    Robert Orlowski

  4. Department of Clincal Oncology, Ain Shams University, Cairo, Egypt

    Mona Kamal

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  1. Mona Kamal
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  2. Xin Shelley Wang
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Corresponding author

Correspondence to Xin Shelley Wang.

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Conflict of interest

Teresa M. Zyczynski and Catherine Davis are employees of Bristol-Myers Squibb. The MD Anderson Symptom Inventory (MDASI) and its modules are copyrighted and licensed by The University of Texas MD Anderson Cancer Center and Charles S. Cleeland. Charles Cleeland and Xin Shelley Wang have a financial interest in the MDASI and its modules. The authors have no other financial conflict of interest to disclose. The other authors declare that they have no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Kamal, M., Wang, X.S., Shi, Q. et al. Symptom burden and its functional impact in patients with “symptomatic” relapsed or refractory multiple myeloma. Support Care Cancer 29, 467–475 (2021). https://doi.org/10.1007/s00520-020-05493-y

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